White paper DOCUMENTED PROBIOTICS FOR HEARTY KIDS & TEENS

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1 White paper DOCUMENTED PROBIOTICS FOR HEARTY KIDS & TEENS

2 Kids & teens AND THEIR MICROBIOTA Probiotics are well-positioned to develop a range of kids and teens specific food supplements. They combine the advantage of scientific evidence, safety, and benefit from an important public awareness about the key role of the gut microbiota in health maintenance. Lallemand Health Solutions has selected a range of well-documented strains and combinations that can address many health concerns from young children to teenagers: natural defenses with gut health and immunity, stress and healthy teeth and gum. When combined with the right delivery format and flavour, these can help formulate targeted supplements for hearty kids and teens! CHILDHOOD IS A KEY PERIOD FOR ESTABLISHMENT OF BOTH THE IMMUNE SYSTEM AND GUT MICROBIOTA. SO Soon after birth, a baby s gastrointestinal tract is colonized by a specific microbiota through breastfeeding and the environment. This microbiota is organized in populations and evolves in the intestines with time. A recent large study [Odamaki et al., 2016] shows that a mature, adult-like microbiota is achieved after 3 years old, remains roughly consistent in healthy individuals (diseases, medicines, many stressors can change this balance throughout life) and changes again in elderly people (Figure 1). Evolution of the microbiota with age Relative abundance (%) 100% 80% 60% 40% 20% 0% Actinobacteria Bacteroidetes Firmicutes Proteobacteria Others Years old Figure 1: Adapted from Odamaki et al., Evolution of the digestive microbiota with age from a large study conducted in 364 healthy Japanese people. From 0 to 3 years old, Actinobacteria, which include Bifidobacteria are predominant and rapidly decrease, while Firmicutes, which include Lactobacilli, become predominant from 3 years old. 0 to 3 years old Proteobacteria, Bacteroidetes, Actinobacteria (incl. bifidobacteria) Firmicutes (incl. lactobacilli) 3 years old Adult-like microbiota New changes occur in elderly only 2

3 IN CHILDREN AND TEENAGERS, LIFE SATISFACTION DECLINES WITH AGE AND SELF-RATED POOR HEALTH INCREASES, DEPENDING ON COUNTRIES. SO According to a large WHO survey, 10-30% of 15 years olds girls and boys rate their health as fair or poor [WHO Health policy for children and adolescents, 2014]. In this context, the supplementation of children s diet with probiotics as a natural way to boost their natural defenses has become increasingly advocated. However, beyond those primary, most documented areas for probiotics namely gut health and immunity, other key issues in children and teenagers could also be linked to the microbiota balance and become potential target for innovative probiotic solutions, in particular occasional stress or oral health (Figure 2). Natural defenses Kids and Teens microbiota balance Figure 2: The microbiota is at the crossroad of many children and teenagers health concerns, which represent as many potential targets for probiotics. WHICH FORMULA FOR WHICH EFFECT? The number of probiotic formulas on offer for children is now booming and expected to grow as health conscious parents are always looking for natural, holistic solutions to support their children s health and they are increasingly aware of the importance of digestive microbiota establishment and balance in children. How to select the best options? What to look for? Probiotic microorganisms are all different and most effects are species and strain specific: clinical and in vivo evidences of efficacy should be provided for the given strain. Reported motivations for use of dietary supplements among US kids & teens Participants can select more than one motivation To improve overall health To stay healthy To supplement the diet To prevent health problems To boost immunity 13.9% 20% 22.7% 37.2% 41.1% [Bailey et al., 2013] Use of dietary supplements 3

4 IMMUNITY IMPROVES WITH AGE In the first years of life children are prone to common infections (common cold, ear nose throat, gastro intestinal infections ) as their immune system is building up. This is a particular concern for parents in the first years of socialization (nursery, school), when repeated infections occur, impacting the whole family s quality of life. The gut microbiota represents the first line of defense in the gut, forming a protective barrier along the intestinal lumen, but also through several biological mechanisms. By enhancing the natural gut microbiota, probiotics can help keep pathogens at bay through several actions, such as competitive exclusion. For example, Lactobacillus helveticus Rosell -52 binds to the attachment sites of pathogenic bacteria such as enteropathogenic Escherichia Coli on intestinal epithelial cells, avoiding pathogen installation and translocation. Probiotics have also been shown to improve the intestinal barrier function and enhance epithelium permeability and integrity, or enhance mucus production. Not only these, which represent the first lines of defense of the gut, but also the immune response itself, both innate and acquired (or memory) can be influenced by probiotics, even at the gene expression level [Mac Pherson et al., 2017] Average episodes related to occasional lowered immunity a year Clinical studies on immunity in children These scientific data are validated by clinical studies in children. Cazzola et al. published a study involving 135 healthy, schoolage children who had suffered from at least 3 episodes of common infections during the previous winter. A 3-month supplementation with PROBIOBABY, a children specific synbiotic formula (Bifidobacterium bifidum Rosell -71, Bifidobacterium infantis Rosell -33, Lactobacillus helveticus Rosell -52 and FOS), was able to decrease the risk of occurrence of common infections in these children by 25% vs placebo, and to limit school absenteeism (Figure 4). Other studies confirm the synbiotic s effects on children s immunity, in particular through positive effect on immunosurveillance, like increased IgA expression in children with low IgA level [Pantovic et al., 2012] [Chen et al., 2007]. Another study [Stojkovic et al. 2016] suggests that this positive effect could be due to improvement of immune maturity <2 year-olds Preschool-aged kids Kindergartners Teenagers Children and Cold (2017) WebMD Medical Reference. 4

5 PROBIOBABY S effects on children s natural defenses % of children with at least one adverse health event % of children with at least one lost day of school %* Placebo PROBIOBABY -40%* Placebo PROBIOBABY *p<0.05 Figure 4: Effects of PROBIOBABY on the percentage of children who developed infection and the number of children who missed at least one day of school due to adverse health event (p<0.05) [Cazzola et al., 2010] Moreover, based on several safety and tolerance studies and a track-record of safety, the synbiotic formula has been recognized for its safety in children by the North American authorities. In the US, a panel of independent experts in the field of probiotics confirmed the GRAS (Generally Recognized As Safe) status of the probiotics for infants and children while Health Canada approved the formula for children from 3 months old. Stress impact on immunity of teenagers and young adults As far as they are concerned, teenagers and young adults life-style and occasional stress can also be linked to sub-optimal immunity. Researchers sometimes use academically stressed students as a model of acute psychological stress which is associated with increased incidence of cold and flu. A large probiotic study conducted in 581 stressed students at University of Florida during final exams for the autumn semester [Langkamp-Henken et al., 2015] showed that the students who received B. bifidum Rosell -71 had a higher proportion of healthy days around the risk period as compared to a placebo group. Researchers saw a reduction in the percentage of participants who became ill and fewer episodes of cold/flu when compared with the placebo. In another study conducted in 300 healthy students suffering from frequent colds, a ten-week supplementation with Lactobacillus helveticus LAFTI L10 reduced the systemic symptoms frequency (headache, muscle ache, fatigue and temperature), the occurrence of symptoms of high severity, as well as the use of medication vs a placebo [Eccles et al., 2008]. Such results suggest that teenagers could also benefit from probiotics effects! 5

6 Lallemand Health Solutions provides a wide selection of targeted probiotic formulas and strains with specifically designed delivery forms for Hearty Kids & Teens Available with carefully selected yummy flavors REFERENCES American Psychological Association, Stress in America survey, Bailey, et al. (2013) Why US children use dietary supplements. Pediatric research 74: Bastürk A et al. (2016), Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial. Turk J Gastroenterol Sep;27(5): Bowe et al. (2011) Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future? Gut Pathog Jan 31;3(1):1. Carter et al Common Sleep Disorders in Children. Am Fam Physician.89(5): Cazzola M et al. (2010) Efficacy of a synbiotic supplementation in the prevention of common winter diseases in children: a randomized, double-blind, placebo-controlled pilot study. Ther Adv Respir Dis. - October 2010 vol. 4 no Chen et al. (2007) Mucous membrane immunity enhanced by taking Biostime probiotics. Chinese Journal of Ecology, April 2007 Vol 19, No. 2, pg Children and Cold (2017) WebMD Medical Reference. Culpepper, T., et al. (2016). Bifidobacterium bifidum R0071 decreases stress-associated diarrhoea-related symptoms and self-reported stress: a secondary analysis of a randomised trial. Beneficial microbes: Diop L, Guillou S, Durand H (2008). Probiotic food supplement reduces stress-induced gastrointestinal symptoms in volunteers: A double-blind, placebocontrolled, randomized trial. Nutr Res 28(1) 1-5. Eccles et al. A study on winter infections in students to determine if oral treatment with the probiotic Lactobacillus acidophilus LAFTI L10 helps to support the immune system. Unpublished. Jindal G et al. (2011) A comparative evaluation of probiotics on salivary mutans streptococci counts in Indian children. Eur Arch Paediatr Dent 2011;12: Langkamp-Henken et al. 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(2016) Age-related changes in gut microbiota composition from newborn to centenarian: a cross-sectional study, BMC Microbiology. Osemene (2015) Irritable Bowel Syndrome in Children and Adolescents, US Pharmacist 40(5): Pantovic (2012) Serum immunoglobulin levels in children with respiratory infections who used a synbiotic dietary supplement. PONS Med J 2012; 10(1):7-11. Purunaik S. et al. (2014) To Evaluate the Effect of Probiotic Mouthrinse on Plaque and Gingivitis among Year Old School Children of Mysore City, India-Randomized Controlled Trial. Global Journal of Medical Research: J Dentistry and Otolaryngology Volume 14 Issue 4 Version 1.0 Year Research for the Schools Health Education Unit report in Boots WebMD Chhildren s and parenting health center. Ritvo et al. (2011) Psychosocial judgements and perceptions of adolescents with acne vulgaris: A blinded, controlled comparison of adult and peer evaluations. BioPsychoSocial Medicine 5:11. Stojkovic et al. (2016) Clinical trial / experimental study (consort compliant): Optimal time period to achieve the effects on synbiotic-controlled wheezing and respiratory infections in young children. Srp Arh Celok Lek Jan-Feb;144(1-2): Thakkar PK et al. (2013) Effect of probiotic mouthrinse on dental plaque accumulation: A randomized controlled trial. Dent Med Res 2013;1:7-12. Tlaskal et al. (1995) Lactobacillus acidophilus in the treatment of children with gastrointestinal illnesses. Česko-Slovenská Pediatrie 51: Tlaskal et al. (2005) Probiotics in the treatment of diarrheal disease of children. Nutrition, Aliments Fonctionnels, Aliments Santé 3: Volkova et al. (2011) Impact of the impaired intestinal microflora on the course of acne vulgaris Klin Med (Mosk). 2001;79(6):39-41 [Article in Russian]. WHO Health policy for children and adolescents, N 7Health behaviour in school-aged children (hbsc) study: International report from the 2013/2014 survey. 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